This book challenges the assumptions of the event-dominated DSM model of posttraumatic stress disorder. Bowmam examines a series of questions directed at the current mental health model, reviewing the empirical literature. She finds that the dose-response assumptions are not supported; the severity of events is not reliable associated with PTSD, but is more reliably associated with important pre-event risk factors. She reviews evidence showing the greater role of individual differences including trait negative affectivity, belief systems, and other risk factors, in comparison with event characteristics, in predicting the disorder. The implications for treatment are significant, as treatment protocols reflect the DSM assertion that event exposure is the cause of the disorder, implying it should be the focus of treatment. Bowman also suggests that an event focus in diagnosis anad treatment risks increases the disorder because it does not provide sufficient attention to important pre-exisiting risk factors.
"This interesting and well-researched book will challenge researchers and clinicians as it raises fundamental questions about the nature of PTSD."
"…a useful guide to the literature for those genuinely interested in the field and an important contribution in the effort to find a firm theoretical footing for future clinical work."
"Sometimes psychological theories drive us in wrong directions. Marilyn Bowman has now posted some clear signs that cannot be ignored. Every corner of her book re-interprets familiar landscapes on the basis of solid research. But far from being an intellectual exercise, she takes us on an exciting journey down the rapids of life. When I finished reading, nearly every page of my review manuscript was ablaze with highlighter."
—Loren Pankratz, Ph.D.,
Oregon Health Sciences University
"Tightly argued and exhaustively researched, this book shatters many popular notions about posttraumatic stress disorder. Through numerous lines of evidence, Bowman shows that we greatly overestimate the ability of traumatic events to cause lasting psychological distress, and similarly exaggerate the efficacy of psychotherapy for trauma victims. Every professional who deals with trauma should read this outstanding volume."
—Harrison G. Pope, Jr., MD,
Harvard Medical School
Contents: Preface. Is There a Problem in Understanding Post-Event Distress? How Prevalent Are Toxic Events and Event-Attributed Clinical Distress Disorders? Do More Terrible Events Lead to More Serious Disorders? What Are Typical Responses to Direct Exposure to Toxic Life Events? What Are the Effects of Indirect Toxic Exposures? How Much Do Individual Differences in Pre-Event Competencies Affect Responses to a Toxic Event? How Powerful Are Individual Differences in Emotionality? Do Beliefs Affect Individual Reactions to Toxic Events? Do Groups Differ in Post-Event Reactions? Which Has More Power in Determining Distress, the Event or the Person? Why Are Clinicians Reluctant to Look for Causes Beyond the Event? How Important Are Emotions as a Guide to Well-Being? Can Professional Treatments Remedy Event-Attributed Distress? Conclusion and Implications.